Timing of code status documentation and end-of-life outcomes in patients admitted to an oncology ward

Abstract

Guidelines recommend documentation of care preferences for patients with advanced cancer upon hospital admission.We assessed end-of-life outcomes for patients who did or did not have code status (CS) documented within 48 h of admission. This was a retrospective cohort study of patients who died on an inpatient oncology ward between January 2004 and February 2009. Primary end-of-life outcomes were "code blues" and cardiopulmonary resuscitation (CPR) attempts; secondary outcomes included unsuccessful CPR attempts, intensive care unit (ICU), consultations, and ICU admissions. Using logistic regression, outcomes were compared between those with and without CS documentation ≤ 48 h from admission (full code or do-not-resuscitate), controlling for significant confounders. The 336 patients had a median age of 61 years; 97 % had advanced cancer. The median time from admission to death was 12 days (range <1-197 days); 151 patients (45 %) had CS documentation ≤ 48 h from admission. Controlling for confounders of reason for admission and marital status, patients with CS documentation ≤ 48 h from admission had fewer "code blues" (2 vs. 15 %; adjusted odds ratio(AOR) 0.12, 95% confidence interval (CI) 0.02-0.43), CPR attempts (1 vs. 11 %; AOR 0.12, 95 % CI 0.01-0.51), unsuccessful CPR attempts (0 vs. 11 %), ICU consultations (9 vs. 30 %; AOR 0.19, 95 % CI 0.08-0.40) and ICU admissions (2 vs. 5 %; AOR 0.18, 95 %CI 0.02-0.85). In patients who died on an oncology ward, CS documentation within 48 h of admission was associated with less aggressive end-of-life care, regardless of the reason for admission.